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Il Giornale Di Chirurgia 2015Primary malignant melanoma originating from the small intestine is extremely rare. Only a limited number of cases are described in the literature. Most commonly small... (Review)
Review
Primary malignant melanoma originating from the small intestine is extremely rare. Only a limited number of cases are described in the literature. Most commonly small intestine is affected by metastatic tumors from other primary lesions. We present a case of a 68-years old male diagnosed with primary malignant melanoma as an ulcerated and bleeding mass in the jejunum--located 40 cm away from the Treitz band. In our case the diagnosis was confirmed at laparotomy and enterectomy. Histology revealed a neoplastic infiltration involving the entire intestinal mucosa, with atypia of neoplastic cells and immunoreactivity to HMB45(+), Melan A(+) and S100(+), confirming the diagnosis of melanoma. There was not revealed a primary lesion in the skin, eye, anus, rectum or in other location by the post-operative investigation. An eleven-month close follow-up has not revealed any metastasis. Therefore a definitive diagnosis of primary malignant melanoma was set.
Topics: Aged; Biopsy; Diagnosis, Differential; Digestive System Surgical Procedures; Humans; Jejunal Neoplasms; Male; Melanoma; Treatment Outcome
PubMed: 26188758
DOI: No ID Found -
Annals of Surgery Oct 1975Nutritional status was investigated in 10 patients who had previously undergone total gastrectomy without evidence of malignancy. The ability of these patients to ingest... (Comparative Study)
Comparative Study
Nutritional status was investigated in 10 patients who had previously undergone total gastrectomy without evidence of malignancy. The ability of these patients to ingest and absorb adequate amounts of nutrients was examined. Metabolic balance studies were also performed to discover how effectively these patients could accumulate and use the absorbed nutrients. In the controlled hospital situation, the amount of food ingested was greater than the amount required for maintenance of Ideal Body Weight. Although mild malabsorption of fat and nitrogen was documented, weight gain and positive nitrogen balance occurred. In direct contrast, food intake significantly decreased when the patients returned to their home environment. While severe malabsorption may contribute to malnutrition in the individual patient, the most common mechanism responsible for postoperative malnutrition was inadequate intake. In the occasional patient with severe malabsorption, the universal demonstration of jejunal anaerobic bacterial overgrowth offers important therapeutic implications. The relative importance of pancreatico-biliary insufficiency in promoting malabsorption remains to be determined. Construction of a Hunt-Lawrence jejunal pouch was not found to favorably affect caloric intake, weight gain, degree of malabsorption, or dumping symptoms. Although some degree of malnutrition does result from total gastric resection, in most cases it is mild and potentially correctable. Avoidance of indicated total gastrectomy due to fears of progressive postoperative malnutrition is unwarranted.
Topics: Adult; Aged; Bile Acids and Salts; Body Weight; Dietary Carbohydrates; Dietary Fats; Dietary Proteins; Female; Gastrectomy; Humans; Intestinal Absorption; Jejunum; Malabsorption Syndromes; Male; Middle Aged; Nutrition Disorders; Nutritional Requirements; Pancreatic Diseases; Postgastrectomy Syndromes; Satiety Response; Stomach Ulcer; Time Factors; Zollinger-Ellison Syndrome
PubMed: 1180580
DOI: 10.1097/00000658-197510000-00007 -
Chirurgia (Bucharest, Romania : 1990) 2019Duodenal polyposis (DP) is often associated in patients with in patients with familial adenomatous polyposis (FAP) and the risk of malignancy is endoscopically assessed...
Duodenal polyposis (DP) is often associated in patients with in patients with familial adenomatous polyposis (FAP) and the risk of malignancy is endoscopically assessed using the Spigelman score. Endoscopic therapy is the first option for PD while surgery is indicated for the advanced stages of the disease (Spiegelman III-IV). Pancreas-sparing duodenectomy (PSD) was proposed as a less aggressive alternative to pancreatoduodenectomy (PD), leaving the entire pancreas in situ while the number of anastomoses is reduced. Open PSD with Billroth or pillorus preserving reconstruction is the general used. The use of a Roux limb is very limited in literature, as it increases the procedure complexity, the number of anastomosis and it may reduce the endoscopic access for the postoperative surveillance after total duodenectomy. We aim to describe the technique for Laparoscopic Pancreas Sparing Total Duodenectomy (LPSTD) with Roux-en-Y reconstruction and to present the procedure's outcomes in a patient presenting Spigelman IV duodenal polyposis associated with FAP after open total colectomy. Laparoscopic Pancreas Sparing Total Duodenectomy (LPSTD) with antrectomy cholecystectomy and Roux en Y reconstruction was performed in a 39-year-old man with a history of FAP, open colectomy with ileorectal anastomosis and duodenal polyps. The preoperative investigations and the surgical steps of the laparoscopic approach are described in details. The operative time was 280 minutes. Two postoperative complications were encountered, a self-limited pancreatico-jejunal anastomosis hemorrhage occurred in POD 1 and necrosis of the cystic duct stump with bile peritonitis (POD7). Both of them required laparoscopic exploration. Oral feeding was introduced in the POD 2. The patient has been discharged in the POD 14. No other complications like delayed gastric emptying, pancreatic or biliary fistula at the site of PJA or ulcer were encountered. The 6 months postoperative evaluation, including the CT scan and the endos-copic retrograde inspection of the neo-papilla revealed no recurrence on the jejunum. Although it is a complex technique, LPSTD represents a good alternative to PD for patients with FAP and large, periampullary villous adenoma especially those with high grade dysplasia. The use of laparoscopy and of Roux en Y reconstruction may reduce the postoperative morbidity rate in PSD.
Topics: Adenomatous Polyps; Adult; Anastomosis, Roux-en-Y; Digestive System Surgical Procedures; Duodenal Neoplasms; Duodenum; Humans; Laparoscopy; Male; Pancreas; Treatment Outcome
PubMed: 31511136
DOI: 10.21614/chirurgia.114.4.502 -
Annals of Surgery Nov 1977The effect of intrajejunal infusion of a fat solution on pentagastrin-stimulated (0.5 microgram/kg-hr) gastric acid secretion was studied in five duodenal ulcer patients... (Comparative Study)
Comparative Study
The effect of intrajejunal infusion of a fat solution on pentagastrin-stimulated (0.5 microgram/kg-hr) gastric acid secretion was studied in five duodenal ulcer patients before and three to five months after truncal vagotomy. Preoperatively mean acid output was reduced from 41 +/- 5.2 meq H+/hr to 15.4 +/- 1.3 meq H+/hr (p less than 0.005), and postoperatively from 17.4 +/- 2.6 meq H+/hr to 12.7 +/- 2.4 meq H+/HR (P less than 0.01), demonstrating that fat induced jejunal inhibition of gastric acid secretion partly or wholly is humorally mediated. Furthermore the study shows that fat induced jejunal inhibition of acid secretion in duodenal ulcer patients seem to be of the same magnitude as previously found in healthy subjects.
Topics: Adult; Duodenal Ulcer; Female; Gastric Juice; Humans; Jejunum; Lipids; Male; Middle Aged; Pentagastrin; Vagotomy
PubMed: 921350
DOI: 10.1097/00000658-197711000-00005 -
Canadian Medical Association Journal Dec 1970During the past 40 years, after gastroenterostomy and pyloroplasty for duodenal ulcer had been replaced by partial gastrectomy in many centres, partial gastrectomy... (Comparative Study)
Comparative Study Review
During the past 40 years, after gastroenterostomy and pyloroplasty for duodenal ulcer had been replaced by partial gastrectomy in many centres, partial gastrectomy itself gave way to combinations of vagotomy with gastroenterostomy, pyloroplasty or antrectomy. Opinions differ concerning the procedure of choice and in this paper the author examines the causes of this diversity of opinion and assesses the reliability of conclusions that can be drawn about the elective treatment of duodenal ulcer today. Most reports of results from various operations have come from retrospective studies, and the causes of variability among such reports are analyzed to point out the great difficulty in making a valid judgment about the relative worth of the various operations used to treat duodenal ulcer. Results of some of the few prospective studies with randomized operations assessed blindly are then presented and note is taken of the surprising observation that greatly different operations appear to give remarkably similar results. From the data available the author develops a logical way of approaching the choice of operation for the various problems related to duodenal ulcer that require elective surgical treatment.
Topics: Bile; Body Weight; Diarrhea; Dumping Syndrome; Duodenal Ulcer; Female; Gastrectomy; Gastroenterostomy; Gastrointestinal Hemorrhage; Humans; Jejunum; Male; Nausea; Postoperative Complications; Pylorus; Sex Factors; Statistics as Topic; Vagotomy; Vomiting
PubMed: 4922168
DOI: No ID Found -
Medicine Jan 2023Endoscopic injection sclerotherapy (EIS) is a common treatment for patients with liver cirrhosis and esophageal varices. It can effectively treat variceal rupture and...
RATIONALE
Endoscopic injection sclerotherapy (EIS) is a common treatment for patients with liver cirrhosis and esophageal varices. It can effectively treat variceal rupture and bleeding caused by liver cirrhosis. However, EIS has many complications, including postoperative bleeding, retrosternal pain, esophageal ulcers, esophageal stenosis, and ectopic embolism. Intramural hematoma of the esophagus (IHE) is a rare complication of EIS that can lead to chest tightness, chest pain, and dysphagia.
PATIENTS CONCERNS
A 55-year-old man developed severe nausea and vomiting accompanied by chest pain after EIS.
DIAGNOSIS
Comprehensive imaging features, the patient was diagnosed as IHE.
INTERVENTIONS
A vascular clamp was used for hemostasia, and a feeding tube was placed in the patient's jejunum.
OUTCOMES
After the removal of the jejunal feeding tube and the intake of a semiliquid diet, the patient had no episodes of chest pain, chest tightness, or dysphagia and was discharged after 2 days of observation.
LESSONS
Although IHE rarely occurs after EIS, we should not overlook its risk. The occurrence of IHE is not directly related to the number of EISs received or the degree of liver cirrhosis but is more likely related to postoperative nausea and vomiting. Therefore, timely medication and observation are particularly important for patients with nausea and vomiting after endoscopic treatment.
Topics: Male; Humans; Middle Aged; Sclerotherapy; Deglutition Disorders; Esophageal and Gastric Varices; Liver Cirrhosis; Hematoma; Chest Pain; Vomiting; Gastrointestinal Hemorrhage
PubMed: 36705374
DOI: 10.1097/MD.0000000000032752 -
Revista Espanola de Enfermedades... May 2023A 61-year-old woman admitted for epigastric abdominal pain, three months of evolution, worsens after ingestion, associating abdominal distension and constipation....
A 61-year-old woman admitted for epigastric abdominal pain, three months of evolution, worsens after ingestion, associating abdominal distension and constipation. Physical examination: abdominal pain and distension in the mesogastric zone. Blood tests: slight increase in C-reactive protein; abdominal X-ray: the small bowel dilatation; computed tomography scan: small bowel obstruction due to intussusception. An exploratory laparotomy was performed, confirming a mechanical intestinal occlusion secondary to 5 centimeters jejunal intussusception (image 3); It was execute an intestinal resection with adequate margins and an anisoperistaltic mechanical side-to-side anastomosis. Correct postoperative evolution; hospital discharge on the sixth day. Pathology report: polypoid intussusception, 4.3x3.3 centimeters, superficial ulceration, edema, chronic inflammation; resection margins without alterations.
PubMed: 37204085
DOI: 10.17235/reed.2023.9698/2023 -
Annals of Surgery Jun 1933
PubMed: 17866988
DOI: 10.1097/00000658-193306000-00008 -
Pharmaceutical Research Jun 2001To determine the human jejunal permeability of cimetidine and ranitidine using a regional jejunal perfusion approach, and to integrate such determinations with previous... (Comparative Study)
Comparative Study
PURPOSE
To determine the human jejunal permeability of cimetidine and ranitidine using a regional jejunal perfusion approach, and to integrate such determinations with previous efforts to establish a baseline correlation between permeability and fraction dose absorbed in humans for soluble drugs.
METHODS
A sterile multi-channel perfusion tube, Loc-I-Gut, was inserted orally and positioned in the proximal region of the jejunum. A solution containing cimetidine or ranitidine and phenylalanine, propranolol, PEG 400, and PEG 4000 was perfused through a 10 cm jejunal segment in 6 and 8 subjects, respectively.
RESULTS
The mean Peff (+/- se) of cimetidine and ranitidine averaged over both phases were 0.30 (0.045) and 0.27 (0.062) x 10(-4) cm/s, respectively, and the differences between the two were found to be statistically insignificant. The mean permeabilities for propranolol, phenylalanine, and PEG 400 averaged over both phases and studies were 3.88 (0.72), 3.36 (0.50), and 0.56 (0.08) x 10(-4) cm/s, respectively. The differences in permeability for a given marker were not significant between phases or between the two studies.
CONCLUSIONS
The 10-fold lower permeabilities found for cimetidine and ranitidine in this study, compared to propranolol and phenylalanine, appear to be consistent with their less than complete absorption in humans.
Topics: Adolescent; Adult; Anti-Ulcer Agents; Cimetidine; Humans; Intestinal Absorption; Jejunum; Perfusion; Permeability; Ranitidine
PubMed: 11474776
DOI: 10.1023/a:1011020025338 -
British Medical Journal Sep 1972
Topics: Adult; Bone Diseases; Celiac Disease; Colon, Sigmoid; Diet Therapy; Female; Glutens; Herpesviridae Infections; Histiocytes; Humans; Ileum; Intestinal Absorption; Jejunum; Liver; Liver Diseases; Lymphocytes; Necrosis; Neutrophils; Ulcer
PubMed: 4341971
DOI: No ID Found